All about Medicare  which plan is right for you

Sunday

Part A: Covers inpatient care in hospital, hospice and nursing home and home health care (but not long term
care). Free for most.

Part B: Covers doctor’s visits, tests and other outpatient care. Charges a premium.

Part C: Medicare Advantage plans let private companies offer both Part A and Part B benefits with fewer
out-of-pocket costs than original Medicare. Many charge a premium on top of the Part B premium.

Part D: Prescription drug coverage purchased from a private company.

Medigap: Supplemental insurance from private companies that covers the deductibles and co-insurance not
paid by original Medicare. Plans run from A to N.

Open enrollment: The only period during which beneficiaries may change Advantage plans or opt in or out of
original Medicare. Medigap coverage may be purchased any time.

Doughnut hole: A gap in prescription drug benefits. In 2013, Part D enrollees will pay a monthly premium
and may, depending on the plan, pay a deductible on prescriptions. Once any deductible is met, they pay
copayments or co-insurance for their drugs until total drug spending – what the plan pays and what the
enrollee pays combined – reaches $2,970 for the year. Then the enrollee pays 47.5 percent of the cost of
brand-name drugs and 79 percent of the cost of generics until total out-of-pocket expenses for the year
reach $4,750. After that, the enrollee reaches catastrophic coverage and pays only a small portion of drug
costs, either 5 percent or copayments of $2.65 for generics and $6.60 for brands, whichever is more.

EPIC: A New York program that helps low-income seniors pay for Part D premiums and supplements their
out-of-pockets drug costs. To be eligible, seniors must make less than $35,000 or $50,000 for a couple. For
more information or an application, call 1-800-332-3742 (TTY: 1-800-290-9138).

WHICH PLAN IS RIGHT FOR YOU?

Deciding which Medicare Advantage plan or Medigap policy is right for you requires an individual assessment of your needs and priorities, experts say. Here Tom Julian, director of marketing for Fidelis Care’s central region and Michael Burke, vice president, Medicare, for Excellus BlueCross and BlueShield offer some advice:

* Read “Medicare & You 2013,” a Medicare primer mailed to all enrollees in September.

* Look up and compare coverage options in your area at www.medicare.gov/find-a-plan

* Call your county Office on Aging to talk to a counselor in its Health Insurance Information, Counseling and
Assistance Program (HIICAP).

* Many insurers offer seminars on wading through the options during open enrollment. Some advocacy
groups do as well. Or call health plans and ask questions.

* Decide how much you can afford to pay in premiums and copayments.

* Don’t assume no-premium plans will be cheaper. The lower the premium, the higher the out-of-pocket
costs for care.

* Think about what kinds of care you are most likely to need and look carefully at those costs.

* If you’re looking at plans with networks, make sure your doctors, hospital and pharmacy are included. If
not, see if out-of-network visits are allowed and how much more they cost.

* If you’re choosing a Medicare Advantage plan, decide if you want one with or without prescription drug
coverage.

* Before choosing an Advantage plan or prescription coverage, look up any medications you take in the formulary to see how much you’ll have to pay for them. Most plans divide drugs into groups and charge less for generics and preferred brands than for other drugs.

* If you’re a snowbird or travel a lot, choose either original Medicare and Medigap, or an Advantage plan with a national network so you can get care away from home. (Most plans offer urgent or emergency care during trips.)